Zagkli Fani, Despotopoulos Stefanos, Spiliotopoulos Christos, Chiladakis John
Cardiology Department Patras University Hospital Patras Greece.
J Arrhythm. 2018 Apr 17;34(3):267-273. doi: 10.1002/joa3.12060. eCollection 2018 Jun.
The study was designed to investigate the effect of heart rate and pacing mode on QRS fragmentation (f-QRS). Moreover, the usefulness of f-QRS in distinguishing patients with impaired left ventricular ejection function (EF) and ventricular tachycardia (VT) from patients with normal EF was assessed.
Three hundred and six recipients, with dual-chamber device, with intrinsic narrow or wide QRS complex and preserved atrioventricular conduction were grouped into normal-EF or impaired-EF VT. We analyzed intrinsic narrow f-QRS and wide f-QRS as well as ventricular-paced f-QRS following different heart rates (baseline, 100 bpm) and pacing modes.
In the baseline state, overall, patients with impaired-EF VT (35 ± 9%), compared to those with normal-EF, had more f-QRS (56% vs 27%, <.001) and ventricular-paced f-QRS (62% vs 16%, <.0001). Ventricular pacing conferred both at baseline and at higher heart rate more ventricular-paced f-QRS in patients with impaired-EF VT than in normal-EF (<.001). Detection of ventricular-paced f-QRS markedly improved overall specificity (84%) and positive predictive value (91%) in identifying patients with impaired-EF VT.
Increased heart rate or/and ventricular pacing uncover QRS fragmentations. Detection of ventricular-paced f-QRS adds value toward noninvasive identification of patients with impaired-EF VT.
本研究旨在探讨心率和起搏模式对QRS波碎裂（f-QRS）的影响。此外，还评估了f-QRS在区分左心室射血功能（EF）受损和室性心动过速（VT）患者与EF正常患者方面的实用性。
306名接受双腔装置治疗、固有QRS波狭窄或增宽且房室传导功能保留的患者被分为EF正常或EF受损的VT组。我们分析了固有窄f-QRS和宽f-QRS以及不同心率（基线、100次/分钟）和起搏模式下的心室起搏f-QRS。
在基线状态下，总体而言，与EF正常的患者相比，EF受损的VT患者f-QRS更多（35%±9%对56%对27%，P<.001），心室起搏f-QRS更多（62%对16%，P<.0001）。与EF正常的患者相比，心室起搏在基线和较高心率时均使EF受损的VT患者产生更多的心室起搏f-QRS（P<.001）。检测心室起搏f-QRS在识别EF受损的VT患者时显著提高了总体特异性（84%）和阳性预测值（91%）。
心率增加或/和心室起搏可揭示QRS波碎裂。检测心室起搏f-QRS有助于无创识别EF受损的VT患者。
